Our Expert Weighs In

Bravo to the online responders! An overwhelming majority of you in both phases said that Kara is not a physician and therefore is neither competent to diagnose her friend’s mental state nor to prescribe the right course of treatment, whether medication, therapy, or some combination of the two.

While there were many insightful and helpful comments, four of them seem to sum it up very well:

“Offer encouragement to see a doctor and offer to give him some names. Further, since people with depression find it hard to take the first step, ask Robert if she can help him make the contact with a doctor or offer to go along for the first visit.”

“It is very dangerous to give prescriptions to a person for whom they are not prescribed. If Robert is suffering from bipolar disorder, for example, giving him a general anti-depressant could be disastrous. Moreover, a pill does not automatically ‘fix’ depression, which is why it is generally counseling or other therapies.”

“She can reach out to him to console him, but she should also offer him names of resources (verifiable, and ethical) that may be able to help. She should not give him medication, or cross boundaries.If she has any personal relationships with a doctor, she might ask for advice or counsel, but she should not take the matter into her own hands. And she should not take it upon herself alone. And above all, she should absolutely pray for him…”

“I would do both the second and third in the list of [options — ‘Go be with him to make sure he doesn’t try to hurt himself’ and ‘Offer to drive him to a nearby emergency room and try to get him some help’]. And as much as my heart might wrench for him, I feel I have to be honest and trustworthy to my company as well as to him.”

Many of you who took the surveys said much the same thing. Congrats! Distributing powerful mood-altering drugs without a prescription is no small matter. For a drug company rep to even consider doing so raises red flags for me. What kind of training did she receive about the ethical, legal, and company policy ramifications of crossing such boundaries? How mature and responsible in her job would she be if, at the first request, she contemplates opening the trunk of her car as a free drive-by pharmacy?

Two deeper concerns

Academically, financially, personally and professionally, Kara’s attraction to Robert seems curious to me, somehow out of sync with where she is in her life and career. I’m not meaning to be a snob here, but I am wondering how someone with her talent, gifts, college degree and responsible position with a major pharmaceutical company could be so drawn to a lonely, depressed latte-maker. And then, as he pours his heart out on the phone and asks for free drugs from her samples in the trunk, why doesn’t her common-sense alarm bell go off immediately? I have some concerns about Kara’s own maturity and loneliness.

Several of you who wrote in have dealt with depression and/or a drug issue yourselves and noted that seeing medications — prescription or otherwise — as the answer is way too simplistic! Many “who have been there” attest to this fact. Carefully prescribed and monitored meds may be part of the solution, but almost never alone. Good counseling and supportive relationships are essential components to mental health. Thanks to those of you who took the time to hammer this point home so personally:

“I’m not a drummer, but otherwise I’ve been where Robert is. He might or might not benefit from pills, but what he really desperately and urgently needs … what he’ll die from the lack of, if not remedied soon, is friends who care enough not to fob him off on a third party or a pill bottle.”

Lots of options

As so many who commented suggest, Kara has a variety of options to help Robert before she should contemplate under-the-table drug gifts. Emergency rooms are duty bound to accept Robert if he presents himself at their door. Also, Kara seems to have sufficient connections in the medical field to find him a sympathetic physician, who would likely meet with Robert gratis. Or Kara could foot the bill herself for an initial visit or two for her friend. There are also agencies (Catholic Charities, SSI, Medicare, free clinics) that could be tapped either for free medical services or to assist with Robert’s healthcare costs. Robert himself — with Kara as his advocate — surely has lots of options short of Kara opening her trunk for complimentary drugs.

However, one respondent did raise a genuine concern about the “facts of life” in the pharmaceutical samples business. Is it possible that physicians and pharmaceutical reps have far “too loose” access to a variety of expensive and critical medicines? While I appreciate a physician offering a free short-term supply of a medication, either to test a patient’s reaction prior to a full prescription or to tide them over until a full prescription arrives, it is a questionable medical and moral practice for physicians (and pharmaceutical reps) to be supplying patients’ full drug needs from their samples closet. If a patient needs financial assistance securing regular prescriptions, there are legitimate channels rather than using “free” under-the-table samples.

Questionable promise

With regard to the wrinkle, if Kara has promised Robert something illegal, unethical and against company policy, she is in no way obligated to deliver on it. It seems to me that the fact that she is being offered a promotion has nothing to do with it. If she now has second thoughts about her promise to share drugs with Robert, she should say so — to herself and to Robert — “on its own merit,” not because of her potential financial gain.

Also, if it is clear in her potential job promotion that she would be duty bound to police such infractions by others, then it ought to be patently clear that she has no business trafficking in such out-of-her-trunk giveaways in the first place. If her employer knew what she was contemplating, they would surely think twice about whether she is the right professional for such a promotion.

I genuinely empathize with Robert in his depression, his life experience, and his need for help. I can honestly say, “I’ve been there myself.” However, with Kara’s even contemplating being his unlicensed M.D. or free pharmacy, my concern is more with her state of mind and maturity than his need for help.

To all those who saw the problem and “red flag” immediately, you can work for my pharmaceutical company anytime. And if you then want to help some new-found friend who is depressed or in need, let’s put our heads together to do so legally, ethically and aboveboard.

Until our next dilemma… have a great Thanksgiving, Advent, & Christmas season!

Bill McGarvey

Bill McGarvey is co-author of Busted Halo’s Freshman Survival Guide. Bill was editor-in-chief of Busted Halo for six years. In addition to having written extensively on the topics of culture and faith for NPR, Commonweal, America, The Tablet (in London), Factual (Spain), Time Out New York, and Book magazine, McGarvey is a singer/songwriter whose music has been critically acclaimed by the New York Times, Washington Post, the Chicago Tribune, Billboard and Performing Songwriter. You can follow him at his website billmcgarvey.com or on Facebook.com/billmcgarvey